Quantifying Efficiencies Gained through Shareable Clinical Decision Support Resources (Maryland)

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Summary:

Clinical decision support (CDS) is a process of providing the right information, to the right audience, in the right format, through the right channel, at the right time, referred to as the “Five Rights” of CDS. More than just alerts and reminders, computerized CDS weaves together people and technology and, when implemented successfully, can improve quality of care. Clinicians at the point-of-care are often the target audience for CDS, but other members of the care team, including patients and families themselves, may also use CDS.

The development and implementation of CDS is often long and resource-intensive. The process usually begins with the need to address a known gap in quality of care. A key step is the translation of evidence-based knowledge, for instance clinical practice guideline recommendations, into a computer-interpretable format. After the CDS is implemented in an electronic health record (EHR) or other technology, it is tested, refined, and deployed for use in clinical practice. Currently, each institution or health care system in the U.S. that manages its own EHR undertakes this translation of evidence into CDS in a siloed fashion. These independent efforts are estimated to cost $25 billion for all recommended care.

A systematic and replicable approach to developing and implementing CDS could reduce costs to health care systems if supported by shareable, interoperable, standards-based tools and resources. For instance, there are opportunities to standardize tools for authoring CDS, structured representations of guidelines that are machine-readable, standards-based logic specifications, and implementation guidance. Health care systems would not have to start from the beginning when developing and implementing CDS.

To support these goals, in 2016 AHRQ launched CDS Connect, a prototype infrastructure for sharing CDS resources. It includes a repository of publicly accessible CDS “artifacts”--documents containing the information for a CDS build--application programming interfaces (APIs) to facilitate automated interaction with the repository, and a CDS authoring tool. For this research, AHRQ contracted MedStar Health Research Institute (National Center for Human Factors in Healthcare) to evaluate the CDS lifecycle in its current state, the “Isolated CDS Build,” to the future state, the “Shareable CDS Resources Build,” through the application of the tools available on the AHRQ CDS Connect platform. The implementation and testing will be conducted at four health care systems, representing different patient populations and two EHR vendors to facilitate a robust evaluation process. This systematic approach will allow for analytic comparisons within sites and between sites to test the efficiencies of shareable CDS resources.

The specific aims of the research are as follows:

  • Understand the role of shareable CDS resources in CDS development and implementation, including the health care systems perspective. 
  • Gain understanding of shareable CDS resources available through AHRQ’s CDS Connect, including describing and quantifying efficiencies gained by a health care system.
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